Cost-effectiveness of primary percutaneous coronary interventionversusthrombolytic therapy for acute myocardial infarction

OBJECTIVES: We sought to determine the long-term cost-effectiveness of two reperfusion modalities in patients with acute ST-segment elevation myocardial infarction: primary percutaneous coronary intervention (PCI) versus thrombolytic therapy. DESIGN: A state-transition model that follows patients from when they develop STEMI until they die was developed. The model encompassed events and health states. Sensitivity analyses were undertaken. RESULTS: For a 65-year old man, life expectancy was 8.3 years with primary PCI and 7.6 years with thrombolytic therapy. The lifetime costs were 19,250 euros (NOK 154,000) and 29,250 euros (NOK 234,000), respectively, for patients living close to an invasive unit. Cost savings from PCI were mainly due to the reduction in future coronary interventions. For patients needing helicopter transport to arrive in time to an invasive unit for PCI, the costs were 24,000 euros (NOK 192,000) and 29,250 euros (NOK 234,000), respectively (all costs undiscounted). For women, the estimates were somewhat higher due to lower mortality. CONCLUSION: Compared with thrombolytic therapy, reperfusion by primary PCI results in greater health benefits at reduced lifetime costs. These findings may have important clinical implications in an increasing cost-conscious health care environment.